We read with great interest the study by Ropero-Luis et al. [1].published in the European Journal of Internal Medicine, on the real-world use of hypertonic saline solution combined with high-dose intravenous furosemide in very elderly patients hospitalised with acute heart failure. This study addresses an important unmet clinical need. Patients of advanced age with preserved ejection fraction, chronic kidney disease, electrolyte disturbances, and multiple comorbidities are frequently encountered in internal medicine wards but remain under-represented in randomised clinical trials.
